Heart Disease

The heart is a muscular organ consisting of 4 hallow chambers – 2 upper and 2 lower. It situates in the middle of the chest, behind, and slightly to the left of the breastbone. The heart pumps oxygen-rich blood and nutrients to the body. The right heart chambers receive oxygen-poor blood from the body and pump it to the lung to replenish the oxygen. Oxygen-rich blood then return to the left heart chambers and send out via arteries to the rest of the body.

The heartbeat starts in the womb. The heart muscles have distinct characteristics as they generate electrical impulse from the sinus node to conducting fibers in the heart. The electrical impulses propagate from the right atrium to the left atrium and down to the ventricles. When the heart muscle cells receive the electrical impulses, they shorten, causing the heart chambers to contract.

Types of heart conditions

• Cardiovascular diseases such as coronary artery disease
• Heart rhythm irregularity (heart arrhythmia)
• Heart defects (congenital heart disease)
• Stenosis or regurgitation
• Cardiomyopathy
• Heart infection
• Pericarditis

Symptoms

The symptoms you experience depend on the type of heart disease you have.

• Cardiovascular disease

  • Chest congestion, chest pressure, feeling as if something heavy sitting on your chest, radiating pain to the chin, shoulder, or left arm which escalates with exercise. In severe cases, the pain occurs without exertion.
  • Dyspnea on exertion, shortness of breath
  • Discomfort when lying down on your back
  • Swelling
  • Irregular heart rhythm
  • Syncope

• Heart Arrhythmias
  

  Heart Arrhythmias is when the heart beats too fast, too slow, or irregularly. The symptoms include:  
  • Heart palpitations
  • Chest pain or discomfort
  • Shortness of breath, dyspnea on exertion
  • Lightheadedness
  • Dizziness
  • Syncope

• Heart Defects
  

  Heart Defects can be detected shortly after birth. Signs and symptoms are:  
  • Pale, gray, blue skin
  • Swelling in the leg, abdomen, or around the eyes
  • Shortness of breath during feeding, leading to poor weight gain
  • Clubbing of finger

• • Breathing difficulties during exercise or doing activities
  • Dyspnea on exertion
  • Swelling in the hands, joints, or feet
  • Blue lips and nails

• Cardiomyopathy
  

  Cardiomyopathy is asymptomatic at the early stage. But it can worsen and show symptoms as follows:  
  • Breathing difficulties while doing activities or relaxing
  • Swelling in the hands, joints, or feet
  • Fatigue, dyspnea  
  • Discomfort when lying down on your back
  • Irregular heart rhythm
  • Dizziness, syncope

• Heart Infection
  

  Heart Infection is the infection of the lining of heart’s chambers and valves (endocardium). Signs and symptoms are:  
  • Shortness of breath
  • Weakness, fatigue
  • Swelling in the leg and abdomen
  • Irregular heartbeat
  • Dry coughs
  • Abnormal rash or bumps on skin and nails

• Valvular Heart Disease
  

  The heart’s valves open and close synchronously for unidirectional blood flow through the heart chambers. Some factors that can damage the heart’s valves, causing symptoms of stenosis or regurgitation, include:
  • Fatigue
  • Shortness of breath, dyspnea
  • Irregular heart rhythm
  • Swelling in the legs, ankles, chest pain
  • Syncope

When to see a doctor

Seek immediate medical care if you have symptoms as follows:

• Chest pain
• Shortness of breath, dyspnea on exertion
• Syncope

Heart diseases are treatable effectively if detected at an early stage. Consult a cardiologist to lower the risk of developing heart diseases. It is crucial for those with a family history of heart conditions.

Causes

The causes differ based on the type of heart disease. The root cause of coronary artery disease with degeneration in the blood vessel wall is unclear, but there are two risk factors classes:

• Controllable and modifiable factors
• Uncontrollable and unmodifiable factors are age, gender, and family medical history. However, these risk factors are manageable to prevent heart diseases.

Risk factors

• Age: Old age increases the risk of coronary artery damage, blockage, and weakened the heart muscle.
• Gender: In general, men are at a higher risk of developing heart diseases; in women, the risk increases after menopause.
• Heredity: People with a family history of heart disease have a higher risk of developing cardiovascular disease, particularly when their parents have the condition at a younger age (before 55 years old in men and 65 in women).
• Smoking: Nicotine constricts blood vessels, and carbon monoxide damages endothelium, leading to a higher risk of cardiovascular disease. Heart attack is more common in smokers than non-smokers.
• Unhealthy diets: Foods high in trans-fat, sodium, sugar, and cholesterol can cause cardiovascular disease.
• Hypertension: Uncontrolled hypertension can harden and thicken the blood vessels, causing stenosis.
• Hyperlipidemia: High LDL-cholesterol in the blood increases the risk of cardiovascular disease.
• Diabetes: It increases the risk of heart disease.
• Obesity: It can lead to other risk factors such as diabetes, high lipid profile, and higher blood pressure.
• Lack of exercise: It is associated with factors including diabetes, high blood pressure, and an increased risk of heart diseases.
• Stress: Emotional risk factors can stimulate the autonomic nervous system affecting the heart and blood vessels and increasing the risk of developing heart diseases.
• Poor oral hygiene: It is associated with heart diseases based on research.

Long-term sequela of heart disease

• Heart failure is the most common complication that occurs when the heart fails to pump sufficient blood to meet the need of the body. It results from several heart conditions, including heart defects, cardiovascular disease, cardiomyopathy, valvular heart disease, and heart infection.
• Acute heart attack occurs when a sudden coronary artery blockage causes death of the heart muscle. The cardiac electrical abnormality can lead to cardiac arrest.
• Stroke is a risk factor for ischemic stroke, which strikes when one of the brain arteries becomes critically narrowed or blocked, causing an inadequate blood supply to the brain.
• Aortic aneurysm is an abnormal dilatation of the body's main artery, the aorta. If ruptured, it leads to rapid, massive internal bleeding and death.
• Peripheral artery disease causes leg and foot pain during physical exertion due to insufficient blood supply (claudication). If there is complete blockage of the blood vessels, tissue gangrene can set in the feet, for instance.
• Cardiac arrest is an acute unanticipated, and complete loss of heart function, breathing, and consciousness. It is commonly a result of life-threatening arrhythmias. Cardiac arrest is a medical emergency; it causes death in a few minutes without immediate intervention.
  When diagnosed with heart disease, appropriate treatment, and preventive measures are mandatory to reduce the risks of developing life-threatening complications.

Prevention

The preventive measures depend on the type of heart disease. Though pinpointing specific causes of coronary artery disease is not possible, there are several factors you can control to lower the risks of developing the condition. These are:

• Do not smoke.
• Manage your blood pressure, cholesterol, and diabetes.
• Exercise regularly, at least 30 minutes a day.
• Eat foods that are low in sodium and trans-fat.
• Keep your weight within the healthy BMI range.
• Reduce your stress
• Maintain good personal hygiene

Diagnosis

Your doctor will do a physical exam and ask about your and your family’s medical history. In addition to a detailed interview, blood tests, and chest X-ray, additional cardiac tests may be in order.

• Electrocardiogram (ECG or EKG) is a quick and painless test.
• Ambulatory ECG Monitoring or Holter ECG is a wearable device to record the heart rate for 24-72 hours to detect irregular heart rhythms not found during the electrocardiogram.
• Echocardiogram uses sound waves to echo or scan and create detailed images and assesses the heart’s structure and size and the function of the heart muscle, valves, walls, and lining.
• Stress test measures the heart rate, blood pressure, cardiac contraction, and electrical abnormality during exercise or after a drug is given to stress the heart. In some cases, a stress echocardiogram can help diagnose cardiovascular disease and heart arrhythmia or assess the heart’s wall motions and arteries.  
• Cardiac catheterization is to insert a short tube into an artery or vein in the leg or arm to check inside the heart or diagnose cardiovascular disease, valvular heart disease, atrial septal defect, or congenital heart disease.
• CT SCAN uses X-rays to create detailed images to determine coronary calcium score; contrast injection for image acquisition of coronary and pulmonary arteries and veins for vascular diseases and cardiomyopathy cardiomyopathy.

Treatment

The treatment modalities depend on the type of heart disease. They are:

• Lifestyle modification: Eating healthy can lower the risk of developing heart diseases. Reduce the consumption of foods that are high in sugar, sodium, trans-fat, and cholesterol. Eat foods with unsaturated omega-3 fats. Eat a variety of fruits and vegetables. Exercise regularly, at least 150-300 minutes per week. Avoid smoking and alcohol.
• Medications: If a lifestyle change is not enough, you can take medications to control your heart condition or manage the risk factors, based on the type of your heart conditions.

Other treatment modalities

• Cardiovascular procedures or surgery
  • Percutaneous coronary intervention: PCI
  • Balloon angioplasty
  • Transcatheter aortic valve implantation
  • Transcatheter ASD secundum closure
  • Radiofrequency catheter ablation of cardiac arrhythmias
  • Transvenous implantation
  • Implantable cardioverter defibrillator: ICD
  • Coronary artery bypass graft surgery
  • Aortic valve repair or replacement
• Rehabilitation and physical therapy can help restore your physical strength so you can resume your daily life. Try to increase exercise if possible as it helps control the risk factors. In the beginning, participate in rehabilitation and physical therapy under the close supervision of a doctor and physical therapy. Adjusting the exercise routine so you can do it on your own, and eventually, you can practice everything at home.